Organization Name: | INDIAN VALLEY PODIATRY ASSOCIATES, P.C. |
NPI Number: | 1245389758 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHILIP J BRESNAHAN (OWNER) |
Mailing Address: | 601 E Broad St Suite 220 Souderton |
State: | PA US |
Postal Code: | 189641263 |
Phone Number: | 2157239688 |
Fax Number: | 2157233310 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 06/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | SC002825L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |